Associate Professor of Gerontology, Department of Behavioral Sciences,Winston-Salem State University, 601 S. Martin Luther King, Jr., Drive,Winston-Salem, NC 27110, USAUnited States
Professor of Sociology, Department of Behavioral Sciences, Winston-Salem State University, 601 Martin Luther King Jr. Drive, 309 Coltrane, Winston Salem, NC 27103, USAUnited States
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Much like the US population in general, the prison population is aging rapidly raising concerns about health care, end-of-life planning, and dying in prison. The impact of aging is amplified within the prison system. Typically, the health status of inmates in their 50’s is physiologically similar to community-dwelling individuals in their 70’s, making 55 old by prison standards.
OpenJournal PUBLISHERS Editorial Aging Inmates: Issues Surrounding Health Care, End-of-Life and Dying in Prison 1* 2 Deborah F. Farmer, PhD1*; Cecile N.Yancu, PhD2 1Associate Professor of Gerontology, Department of Behavioral Sciences,Winston-Salem State University, 601 S. Martin Luther King, Jr., Drive,Winston-Salem, NC 27110, USA 2Professor of Sociology, Department of Behavioral Sciences,Winston-Salem State University, 601 Martin Luther King Jr. Drive, 309 Coltrane,Winston Salem, NC 27103, USA * *Corresponding author Deborah F. Farmer, PhD Associate Professor of Gerontology, Department of Behavioral Sciences,Winston-Salem State University, 601 S. Martin Luther King, Jr., Drive,Winston-Salem, NC 27110, USA; Article information st nd th Received: October 31 , 2018; Accepted: November 2 , 2018; Published: November 14 , 2018 Cite this article Farmer DF, Yancu NC. Aging inmates: Issues surrounding health care, end-of-life and dying in prison. Palliat Med Hosp Care Open J. 2018; 5(1): e1-e3. doi: 10.17140/PMHCOJ-5-e007 3,15 uch like the US population in general, the prison population three times more or $72,000/year compared to $24,000.3,15 is aging rapidly raising concerns about health care, end-of- M life planning, and dying in prison. The impact of aging is amplified Although empirical evidence that incarceration acceler- within the prison system. Typically, the health status of inmates ates aging is lacking,16 the nature of institutionalization interferes in their 50’s is physiologically similar to community-dwelling indi- with self-care. Prison systems generally cope with chronically and viduals in their 70’s, making 55 old by prison standards.1 The 55+ terminally-ill older inmates by handling their needs in within-facili- age group is the fastest growing segment of the prison popula- ty units.17 Centralizing health care services for older inmates within tion2 increasing by 18.1% between 2000 and 2010 compared to a a unit saves money and makes it possible to tailor services more 17% increase in the overall prison population.3 It is estimated that specifically to the needs of this group. These units may be age- within the next ten years one in 5, or 20%, of inmates will be old.4 segregated, for older inmates only, or age-integrated, part of the general prison environment.
Reasons for the graying of the prison population include longer sentences related to minimum mandatory sentencing and Inmates who are paroled or complete their sentences “three strikes” rule, reduced options for early release, revocation of often leave the prison system with serious health problems11 and 2,3,5-10 parole policies, recidivism, and inmates living longer. Math- limited access to community resources to address these problems. ematically, the aging of the Baby Boomer generation has led to For example, incarcerated individuals are not eligible for federal more older adults committing crimes. Older inmates are comprised programs such as Medicare and Medicaid; once released; health of three groups: those aging within the prison system due to lon- care costs are shifted from the prison system to the public sector.3 ger sentences, repeat offenders, and those who are first-time of- fenders in later life.11 A variety of early-release policies reflect one method of addressing the challenge of providing appropriate care for older Premature aging means that older inmates tend to be inmates. Although some argue that in practice early release poli- sicker than the general population with more chronic and life-lim- cies simply shift the burden from one branch of the state to an- iting diseases. This is compounded by lifestyle and environmental other or to the community, others cite the potential to alleviate conditions such as lower socioeconomic status and less prior ac- extreme punishment. These laws/policies essentially fall into four cess to health care resulting in older inmates having poorer health broad categories: medical or compassionate release, medical pa- outcomes such as HIV, hepatitis B and C, tuberculosis, substance role, medical clemency, and geriatric release. The medical or com- 2,5,12,13 abuse, and mental illness. A key concern generated by the passionate release allows for terminally-ill, eligible inmates to die growth of the older inmate population is how to provide and pay outside of prison confines prior to completing their sentences.18 for appropriate environmental conditions and services for older Medical parole may be granted to inmates who require specialized inmates.6 As it now stands, it costs substantially more to house and or extensive treatment but are not necessarily terminally ill.19 Under 4,14 provide care for older, compared to younger, inmates,4,14 about the conditions of medical parole, inmates are expected to return to cc Copyright 2018 by Farmer DF. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which Palliat Med Hosp Care Open J. 2018; 5(1): e1-e3. doi: 10.17140/PMHCOJ-5-e007 serve the remainder of their sentences provided that they recover programs in the United States. Am J Hosp Palliat Med. 2011; 28(4): sufficiently. The state of Virginia recognizes medical clemency in 245-252. doi: 10.1177/1049909110381884 which a terminally-ill inmate who is not eligible for parole may pe- tition the governor for release to family or a community member 6. Kerbs JJ, Jolley JM. A commentary on age segregation for willing to provide care.20 Eligibility for geriatric release, which may older prisoners: Philosophical and pragmatic considerations for or may not include medical parole or compassionate release, var- correctional systems. Crim Justice Rev. 2009; 34(1): 119-139. doi: ies widely. Most states that permit early release for aging inmates 10.1177/0734016808324245 set conditions such as age 60-plus years, the minimum length of sentence served, the severity of offense, e.g. not being a capital 7. Loeb SJ, Abudagga A. Health-related research on older inmates: crime, and physical conditions related to age or need for long-term An integrative review. Res Nurs Health. 2006; 29(6): 556-565. doi: 21 15 care services.21Although release rules vary by jurisdiction,15 reports 10.1002/nur.20177 show one commonality: programs are mired in bureaucracy and the Bureau of Prisons, which administers the programs, is reluc- 8. Loeb SJ, Hollenbeak CS, Penrod J, et al. Care and companionship tant to grant early release.22 Out of the 5,400 applications received in an isolating environment: Inmates attending to dying peers. J Fo- between 2013-2017, the Bureau of Prisons approved 6%; 266 ap- rensic Nurs. 2013; 9(1): 35-44. doi: 10.1097/JFN.0b013e31827a585c plicants died in custody.23 9. Reimer G. The graying of the U.S. prisoner population.J Corr Health Currently, the issue of health and end-of-life care for Care. 2008; 14(3): 202-208. doi: 10.1177%2F1078345808318123 older inmates is being addressed in an ad hoc manner through a patchwork of rules and policies. Although a variety of programs/ 10. Sanders S, Stensland M, Dohrmann J, Robinson E, Juraco K. models have been promoted and adopted in a limited number of Barriers associated with the implementation of an advance care locations, no consensus has been reached on the best mode of planning program in a prison setting. J Soc Work End Life Palliat caring for aging inmates. Each of the programs/policies has its Care. 2014; 10(4): 322-337. doi: 10.1080/15524256.2014.975320 strengths and weaknesses and no one program can meet the variety of needs of older inmates in diverse settings. Regardless of which 11. Loeb SJ, Steffensmeier D. Older male prisoners: Health status, program or model is adopted, something must be done to meet the self-efficacy beliefs, and health-promoting behaviors. J Corr Health needs of the rapidly growing population of older inmates, if not Care. 2006; 12(4): 269-278. doi: 10.1177%2F1078345806296031 on compassionate grounds, then certainly because it makes fiscal sense. The most viable option is for prison systems and communi- 12. Linder JF, Meyers FJ. Palliative and end-of-life care in correc- ty-based health care providers to work together to develop guide- tional settings. J Soc Work End Life Palliat Care. 2009; 5(1/2): 7-33. lines for an evidence-based policy for the best, most cost-efficient doi: 10.1080/15524250903173579 health and end-of-life care options for the aging prison population. 13. Williams B, Abraldes R. Growing older: Challenges of prison CONFLICTS OF INTEREST and reentry for the aging population. In: Greifinger R (Ed), Pub- lic Health Behind Bars: From Prisons to Communities. New York, NY: The authors declare that they have no conflicts of interest. Springer. 2007.